Polycystic ovarian syndrome (PCOS) is a disorder in women that is characterized by ovarian cysts from anovulation and is associated with hyperandrogenism and infertility. The most common symptoms of PCOS include polycystic ovaries, amenorrhea, hirsutism, obesity, insulin resistance, and infertility.
Anti-Mullerian hormone (AMH) is a glycoprotein produced by the ovary, and it plays an important role in maintaining ovarian reserve and modifying the follicles’ response to follicle stimulating hormone (FSH). Recently, there has been an increase in interest about the role that AMH plays in reproductive physiology. Many women of child-bearing age are now being tested for their AMH levels as a measure of both ovarian reserve and PCOS status.
Vitamin D’s role in reproduction has also sparked a lot of interest in recent years because many studies have come showing a correlation between vitamin D deficiency and many pregnancy-related disorders, including PCOS. Vitamin D is primarily produced by the skin in response to UV light exposure, and it can be supplemented in our diets. Earlier studies have shown that seasonal fluctuations in ovulation in countries of high latitude correspond to large seasonal fluctuations in serum vitamin D levels.
The purpose of this study was to clinically test if there is there a relationship between serum AMH levels and seasonal variations in serum vitamin D in women with ovulatory and polycystic ovary syndrome (PCOS). There was little research looking at the clinical relationship between AMH and Vitamin D before this study. The design was a retrospective cohort study that included 340 women aged less than 40 years, with 58 women having PCOS and 282 women having an ovulatory syndrome. This data was collected as part of the subjects’ routine fertility assessment between January and December 2013 at a private fertility clinic in Adelaide, South Australia. The data collected from the subjects included age, BMI, cause of infertility, antral follicle counts (AFC), serum AMH and vitamin D levels, smoking status, and menstrual cycle length for women aged less than 40 years of age. Their serum AMH and vitamin D levels were sampled within the same 4-week period and were retrieved from a database. The hours of sunlight per day and daily UV index were extracted from a database at the South Australian Bureau of Meteorology which is located South Australia. The data analysis was done by analyzing serum vitamin D levels were against seasonal variation in sunlight and UV exposure and serum AMH levels.
The results of this study were that seasonal variations in serum vitamin D were observed between summer and winter, but serum AMH levels were NOT affected by the seasonal fluctuations in serum vitamin D in either the PCOS or ovulatory cohort. It was also found that serum vitamin D levels were not significantly related to the underlying cause of infertility . These results were contradictory to in vitro studies which have shown that vitamin D has the potential to modify AMH production.
I think the results of this study are interesting because previous evidence from in vitro studies would make one believe that serum vitamin D most likely has a direct effect on serum AMH. I think this study is a good example for health care providers and pharmacists that we can not always assume from related studies that drugs, hormones, disease states, etc. have direct effects on each other. It is important to conduct thorough research on topics that do not have direct evidence or findings because it is certainly not appropriate for health care providers and pharmacists to make assumptions based on related literature when treating patients’ disease states. As for the actual topics discussed in the study, I find it interesting that vitamin D deficiency has been previously found to effect problems associating with pregnancy and contraception. I would like to learn more about vitamin D’s role in pregnancy and how women with reproductive disorders are treated for problems with conceiving because I could potentially recommend women to take vitamin D supplements as a pharmacist to help them conceive.
My question posed to colleagues: Do you know anything about how vitamin D deficiency can be related to pregnancy disorders? What are your thoughts about the finding of this study in relation to the previous research completed about factors related to AMH and vitamin D?
Pearce, K, Gleeson, K, Tremellen, K. Serum anti-Mullerian hormone production is not correlated with seasonal fluctuations of vitamin D status in ovulatory or PCOS women. Hum Reprod. 2015;30:2171-2177.